Hysteroscopy - Pain Relief

[HebeJeeby]

I’ve just been taken off the cancer pathway as I’ve had a test of the lining of my womb and all is ok. I’ve been experiencing bleeding whilst in HRT and the Dr wanted to get me tested. The lining of my womb is 2mm thicker than it should be hence the test which has come back normal. However, due to the excessive bleeding they want to do a hysteroscopy to investigate the bleeding.

I’ve read that this procedure can be very painful and indeed 2 women I know found the pain excruciating and couldn’t continue. One woman had to then have it under general anaesthetic. I rang to ask about pain relief and got told to have a paracetamol one hour before my appointment. I said that i wasn’t happy with this for the reasons I’ve just written and the NP is going to call me on Monday to discuss. I found the initial procedure to suck cells form my womb very painful but it was bearable as it only lasted about 30 seconds. Apparently a hysteroscopy can take anything from 5 to 30 minutes.

Has anyone had a hysteroscopy and what was it like? Did you get offered or have any pain relief. I’m feeling so anxious about it and can’t believe that anyone would think I took to shove a camera into the womb and not think that this is going to hurt. Can I insist on proper pain relief like a local anaesthetic? Thank you.

I had local anaesthetic in my cervix (it was offered by the consultant before the procedure) I didn’t feel the injections at all.

I had a hysteroscopy with just the camera, but stopped it before the biopsy stage, as it was unbearable. The subsequent after pain was pretty bad, too.
I returned for the biopsy with spinal anaesthesia, and although it was more of a palaver, my anxiety was far less.

I know some women are able to go through this procedure without massive pain and anxiety, but it isn't very pleasant discovering in the midst of it that you are not one of them!
And I feel strongly that adequate pain relief should be offered as a matter of course, without the briskness and bullshit about “discomfort” and railroading to proceed that sometimes happens in women's health.

i had a hysteroscopy / polyp removal in France, with GA and no suggestion that anything else was appropriate 🤷‍♀️ . It was treated as day surgery, done in a clinic.

I know someone who had this, and she said she was screaming in pain. The nurse was not sympathetic and made her feel like it was a fuss over nothing.

She said never again without full pain relief.

I’ve had 2. I took paracetamol before hand and it was ok. I think being tense and anxious (I was more anxious the second time) makes it worse so try to breathe through it and think of other, nicer things. At its worse it was like bad period pains and then mild cramping after. If it’s too much you can stop it but I seriously wouldn’t go straight for a general anaesthetic without trying first. I felt worse for longer when I’ve had GAs for other things. Good luck!

The amount of gaslighting that’s gone on by the doctors mentioned in this thread is horrendous. From what you ladies have said it sounds a very painful experience so why they’re advising that paracetamol should be sufficient is ridiculous. OP hope you can have a much pain relief as you want and need and that the procedure goes well.

I had a hysteroscopy and biopsy fairly recently and took a dose of paracetamol and a dose of ibuprofen (with a snack) half an hour before the appointment time. By the time forms were filled in etc they had kicked in and the procedure was mostly just uncomfortable. There was a pain from the biopsy but I could cope as it wasn't for very long.
I was quite relaxed though for a once - I've had some thoroughly unpleasant smear tests when I've been too tense and I think that may have made a lot of difference.

I had a GA. I wanted them to do the investigation properly without me stressing and wriggling. I was out for less than an hour.

This was my experience too. A couple of paracetamol beforehand was all I needed. It wasn't painful at all, hardly uncomfortable even.

I had a hysteroscopy 3 months ago and just took paracetamol and ibuprofen as recommended. It was a bit uncomfortable because they fill you uterus with saline so they can see with the camera. It certainly wasn’t painful for me but the pressure was a bit uncomfortable because. I had slight cramping and bleeding for a couple of hours after. Then be fine since.
I also had post menopausal bleeding on HRT. Then be fine lining of my uterus was 4mm which was borderline for a hysteroscopy.

I was offered a LA without asking for it, and they said they'd stop if it hurt and book me in under GA. They were gentle and lovely to me which really helped. I haven't had children or a coil so was expecting it to hurt, but it was painless. This was NHS 5 years ago.

I had fibroids removed via this route, and thought I would pass out from the pain of an unmedicated dilation of my cervix to allow the procedure. Please ask about sedation and pain relief. 2 paracetamol is a joke.

What would be worse? Paracetamol and end up in agonising pain as they rumage around inside you because some pp managed on gas and air? ?
Or GA or full spinal and you guaranteed you won't know what's going on as they rummage around inside you

I had mine and polyps removed GA no question under private gynae she did not even suggest otherwise

It’s fucking barbaric what they do to women, strong pain relief should be encouraged

Had one 5 years ago due to post menopause bleeding. Told to take paracetamol prior to the procedure. Had biopsies done. Everything was fine and the pain was just like a period pain. Try to go to the appointment positive and relaxed. It's a privilege to live In a country where such things are free and readily available.

There is a guide by the RCOG which covers this in detail. They do advise that pain relief is offered .

https://www.rcog.org.uk/news/rcog-good-practice-paper-pain-relief-and-informed-decision-making-for-outpatient-hysteroscopy/

The RCOG has published a new Good Practice Paper on Pain Relief and Informed Decision-Making for Outpatient Hysteroscopy. The paper is intended for healthcare professionals and has been published with the aim of optimising patient experience and clinical outcomes.

"Hysteroscopy is a common and valuable procedure used to diagnose and treat gynaecological conditions arising in the uterus.

The majority of women and people have an acceptable experience of outpatient hysteroscopy, with pain levels tolerable to them and rapid recovery. However, for some women it is an unpleasant, and even traumatic, experience because of the pain.

A third of patients undergoing an outpatient hysteroscopy report pain levels at seven or above out of 10 however patient acceptability/satisfaction rates are consistently well above 90%, likely reflecting the brevity, safety and convenience of the procedure. The patient acceptability/satisfaction rates also indicate that pain may not be the main factor in their decision making.

To allow women or people to make informed choices it is vital that clear, accurate written and verbal information is provided, at the time of referral, or beforehand and at the procedure appointment. This should support choices including whether the person wants to proceed with a hysteroscopic procedure and if so, preferences for treatment setting, pain control and type of anaesthesia.

For women and people undergoing an outpatient hysteroscopy, it should be explained that it is impossible to fully anaesthetise the uterus with local anaesthetic and that simple analgesics should be taken 60 minutes before their appointment. Units should also identify a team member to act as a patient advocate during the procedure, exclusively dedicated to looking after the woman’s immediate needs and overall wellbeing rather than technical elements of the procedure."

Mrs Geeta Kumar, Vice President of the Royal College of Obstetricians and Gynaecologists, said: “Delivering hysteroscopy procedures in an outpatient setting offers women a quick, convenient and safe option. However, it is vital that women are supported to make informed choices about their care, and that all steps are taken to minimise the risk of a poor experience. To achieve this aim, we encourage clinicians and units offering this common procedure to ensure their practice is aligned with this paper."

The problem is that having a GA is very costly and uses far more medics than not using one. And not all women want a GA anyway.

I was booked in for a hysteroscopy under GA, as I cannot even have a smear without severe pain. On the day I was offered either spinal block, or full sedation. I took the block, and it was fine. I spent the hour chatting to the anaesthetist whilst the surgeon removed a polyp and took a sample of my womb lining.

Thank you everyone for replying with your experiences, it’s nice to hear the positive stories and thank you for the guidelines in for too. I think I agree with a PP that i don’t want to wait and see if I’m one of the women who do find the experience too painful, I’d rather be offered pain relief first. I will wait and see what the nurse has to say to me tomorrow before making a decision.

I think the biggest issue is that post-menopause, your cervix closes, and if they have to dilate it to gain access to your womb, that is really painful. The other issue is that some doctors are just fucking butchers and shouldn’t be allowed near patients.

@HebeJeeby Can I ask what sort of HRT you're on?

The reason is that your GP (or is it the gynae?) doesn't seem to be following BMS guidance on bleeding when on HRT.

You've had a scan and a biopsy, and all were clear apart from a lining 2mm higher. But- higher than what? Are you post meno and on continuous combined HRT?

Are you on sequential?

The BMS advice is to tailor the HRT usually increasing the progesterone side of it to see if the bleeding stops (first step) and if this doesn't work, to go through the process you're now going through.

I'm only asking because on this forum it seems that many women are being sent for investigations too quickly without going through the recommended process.

It's not always painful. I'm only speaking for myself and I was dilated but it was painless.

No one knows how they will feel until they have had the investigation.

I had one a few weeks ago to remove my coil as the strings had become embedded in the endometrium, I also had a polyp removed and some biopsies taken. I had it under GA. It was suggested without but I asked for sedation as straightforward coil replacement in the past have been difficult enough including fainting (my cervix is tilted so difficult to access apparently), they offered GA rather than sedation.
I’m sure it was quicker and easier for them too that I was asleep! I was awake in recovery 25 minutes after going down to theatre, up to the loo and eating and drinking almost straight away and I was discharged about 2 hours later. I had quite heavy bleeding that evening, like a heavy period. I didn’t really have any pain, I took a couple of doses of paracetamol just in case.
I’d definitely make the same decision again!

I had a hysteroscopy recently and the gynae consultant said it was entirely my choice to have it as an out patient or under GA. She warned me that some find it very painful, and that I was likely to be more difficult for me as I have not had vaginal births. I was so pleased that I did but have to fight for what was my right to choose. The actual GA and procedure experience was absolutely fine.

@JinglingSpringbells hi, thank you for your questions. I’m on Evorel Conti. My lining was 6mm which they said was 2mm thicker than the recommended 4mm. They want to do a hysteroscopy because I have had a lot of bleeding despite being on hrt. There hasn’t been any mention of amending my dose first. I don’t think I am post menopause and am not sure what you mean by sequential. I think I’ll ask about changing my dose tomorrow as well and see what they say. Thank you.

Where I live GA is standard, you are not even given the option of going without. I had very little pain after the procedure and some slightly heavier bleeding.